Public Health Passenger Locator Form: limited onboard exposure† (domestic flights)

Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1181 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1181 Public Health Passenger Locator Form: limited onboard exposure† (domestic flights) Form
0920-1181 Public Health Passenger Locator Form: limited onboard ex Attachment 12 Public Health Passenger Locator Form.pdf Form

Information Collection (IC) Details

IC Title:	Public Health Passenger Locator Form: limited onboard exposure† (domestic flights)	Agency IC Tracking Number:	0920-1181

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1181	Public Health Passenger Locator Form: limited onboard exposure(domestic flights)	Attachment 12 Public Health Passenger Locator Form.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.